The morning news. [volume] (Savannah, Ga.) 1887-1900, 1887-12-14
WHAT TRACHEoToMY IS.
Dr:Valentine Mott Discusses the Crown
Princes Disease.
From the Neto York World.

Princes Disease.
From the Netc York World
Discussing the condition of tho German
Crown Princes throat with a reporter of
the World, Dr. Valentine Mott, the we'll
known surgeon, said: at is doubtful if any
operation can be of much benefit. The only
reports that have reached us surgeons come
through the newspapers. These have been
very full, but they lack that attention to
detail and scientific accuracy which any
surgeon would demand before passing posi-
lively upon the case. Presumably the pub
lished reports have been written by men
who have had no medical training This
makes them unsafe guides to medical man
Pin forming a diagnosis or predicting the
final outcome
1T may, however, be accented that the
disease is cancer, and that its seat is some
where in the trachea If this is so, any
operation for its relief must be exceedingly
difficult and uncertain as to its results The
operation of tracheotomy. which has been
referred to in the dispatches, is easy of per-
Torrance and, of itself, satisfactory in its
results, but alone cen be of no benefit in the
case of the Crown Prince. Almost every
surgeon has at some time performed this
operation. It consists simply in opening
the trachea, or Adams apple from the
outside under the chin. A metallic tube is
then inserted and through it air is supplied
to the lungs 1t will thus be seen that the
indications for tracheotomy are the threat
ened closing of the upper part of the throat
and impending strangulatlon. This condi-
ton may arise in specific liberation of the
throat, or from Group, diphtheria and SINH
lar diseases When strangulation is threat
ened and immediate relief required the ope-
ration is performed and air supplied t. the
lungs through the artificial opening until
the cause of the distress is removed by
proper medical treatment. The tube is then
taken out and the opening heals up without
other bad results than slight scar.
''To be sure, death metimes follows the
operation, but it is usually in spite of it and
not on account of it. That is, the operation
may fail to arrest the progress of the dis
ease, just as any treatment must sometimes
fail to ward off death. Tracheotomy is
also sometimes performed for the purposes
of administering an anRsthetic when an
operation is to be performed in the mouth,
such as would interfere with the admins
6ration of the ether through the ordinary
channel.
$50, if the Crown Prince should be threat
ened with strangulation his physicians
would doubtless have recourse to tracheoto-
my. This, however would not cure the dis
ease or in any way retard it. Other treat
ment would be required for that. Now, if
we take for granted that the disease is can
Ger, which ! do not doubt, two things should
be borne in mind in any scheme of treat
nent: 1t is very hard to determine, under
the conditions which attend the Crown
Princes case, when all the liberated tissue
has been removed--the cancer is still likely
to return in a very short time. These things
make the outlook gloomy A return of the
cancer might be less liable to occur if, be
fore the operation for its removal Is per
formed, the carotid artery on the same side
of the cancer should be tied. This would
be done for the purpose of starving it out
by cutting off the supply of blood. There
are other arteries which would supply
enough blood for the nutrition of surround
ing parts. 49, ....., 49,. a.. ,,u.o.,
trachea might be removed and a metallic
one be substituted This is of doubtful eff
ficacy. We have nothing to guide us in
discussing such an operation. 1t has GER
tainly never been performed in this city
and, | think, nowhere else. II such con-
trivance as the one proposed has ever been
tried or even invented | do not know it.
One might introduce rubber or metallic
tube through what is left of the trachea
after the operation if there is still enough of
the cartilage to hold the tube in. This would
be irritating to the throat and be apt to
hasten a return of the liberation. But if
Une cancer SuOulu uOI TeJuIH anu Ouo Ope-
ration have been complete the tube might
be used for years
Another operation which might be used
is the employment of tracheotomy and the
tracheotomy tube after a previous opera
ton, removing the cancerous growth and
the upper part of the trachea. OF course,
in that case the power of speech would be
lost The Prince could breathe perfectly
well through the tracheotomy tube, but the
haxr 81,
the upper part of the tEachea. Neither of
these operations could be performed, how
ever, if the seat of the cancer is very low
down, as enough of the trachea must be left
in to hold the tube, whether introduced
through the mouth or through an artificial
opening. And even then the disease would
in all probability again assert itself in the
part of the trachea still remaining and rem
der what had previously been done useless.